Shamika Cannon
Charlotte
Summary
Has more than 5 years’ experience in process of verifying insurance coverage for excess carriers and manages claim recoveries, including be not limited to subrogation. Insurance verification while determining the carries cost sharing while monitoring the medical treatment and reserving. Determining the correct coding to ensure compensability of claims. Identifies and appropriately handles claims with third party subrogation potential, SIF and MSA exposure. North Carolina and South Carolina Jurisdictions. Settlement authority, File review, monitor reserves and complete appropriate reserve worksheets, familiar with litigations and mediations.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Workers Compensation Claims Adjuster
Gallagher Bassett
NC
04.2021 - 04.2026
- Adjust lost-time litigated workers compensation claims under close supervision.
- Working knowledge of medical treatment and terms as related to medical only workers compensation claims.
- Communicates claim action/processing with claimant, client, and appropriate medical contact.
- Identifies and appropriately handles claims with third party subrogation potential, SIF and MSA exposure.
- Critical thinking skills to assess compensability of WC claim as it relates to the facts and law jurisdictions. Assist clients with coordination of rehabilitation and re-employability programs for disabled claimants.
- Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
- Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency. Research and analyze claims process.
- Communicates claim action/processing with claimant, client and appropriate medical contact. Identifies and appropriately handles claims with third party subrogation potential, SIF and MSA exposure.
- Ensures claim files are properly documented and claims coding is correct.
- May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.
- Maintains professional client relationships.
- Verify insurance coverage for excess carriers.
Workers Compensation Claims Adjuster
Best IRS - Contract - Gallagher Bassett
SC
10.2020 - 03.2021
- Adjusts minor lost-time litigated workers compensation claims under close supervision.
- Working knowledge of medical treatment and terms as related to medical only workers compensation claims.
- Critical thinking skills to assess compensability of WC claim as it relates to the facts and law jurisdictions. Assist clients with coordination of rehabilitation and re-employability programs for disabled claimants.
- Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
- Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency. Research and analyze claims process.
- Communicates claim action/processing with claimant, client and appropriate medical contact. Identifies and appropriately handles claims with third party subrogation potential, SIF and MSA exposure.
- Ensures claim files are properly documented and claims coding is correct.
- May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.
- Maintains professional client relationships.
- Verify insurance coverage for excess carriers.
- Manages claim recoveries, including be not limited to subrogation.
Workers Compensation Claims Adjuster
Gallagher Bassett Services, Inc.
NC
01.2020 - 05.2020
- Manage, develop, and maintain service relationships with all participants (physicians, providers and administrators) of a provider network.
- Manger medical only and complex claims, medical terminology.
- Investigate, evaluate, negotiate and settle workers’ compensation claims for NC, SC, MD, and VA, DC Jurisdictions. Process claims within standard process. Coordinate return to work and medical reports.
- File review, monitor reserves and complete appropriate reserve worksheets, settlement authority, familiar with litigations and mediations. Make sound judgements to determine claims approval, compensability and denials.
- Determine coverage/compensability, facts of loss and degree of liability/exposure.
- Ability to work under pressure and problem solve and make sound decision
- Obtain facts from insurers, claimants, witnesses.
- Identifies and appropriately handles claims with third party subrogation potential, SIF and MSA exposure
- Provide follow up same day of first report per clients/employers guidelines.
Workers Compensation Claims Specialist
Corvel Corporation
NC
03.2016 - 01.2020
- Supports, develops and maintain service relationships with all participants (physicians, providers and administrators) of a provider network. Resolve claims by determining approval compensability and denial of medical treatment and bill payments. Identifies and appropriately handles claims with third party subrogation potential, SIF and MSA exposure. Working knowledge of medical treatment and terms as related to medical only workers compensation claims. Assist clients with coordination of rehabilitation and re-employability programs for disabled claimants.
- Responds to electronic and direct inquiries from clients about policies, rates, changes, referrals, eligibility, credentialing. Works on projects/matters of limited complexity in a support role. Determine the approximate timely filing of medical claims per state law regulations. File claims within the State Regulations.
- Coordinate medical treatment and ensure proper claims processing. File appropriate documents per State Regulations. North Carolina and South Carolina Jurisdictions. Settlement authority, File review, monitor reserves and complete appropriate reserve worksheets, familiar with litigations and mediations. Customer Service Support. Liaison for medical vendors and billing dept.
- Follow up on legal bill expenses reports. Adhere to clients special handling instructions.
- Refer claims as appropriate and timely, based on exposure and established guidelines.
- Ability to work with others in a team environment.
- Provide customer contact to provide claims information.
Senior Site Coordinator
Lash Group Amerisource Bergen
Charlotte, NC
11.2012 - 03.2016
- Capability of determining a patient Cost Share for procedures performed in a medical office. Collects and reviews all patient insurance benefit information to the degree authorized by the SOP of the program. Administrative Duties. Customer Service Support. Handle Grievance and Appeals. Call Center.
- Completes and submits all necessary medical insurance forms and electronic claims to process the claims in a timely manner as required by all third-party payers. Researches and resolves any electronic claim denials. Familiar with HIPAA Laws, Medical Terminology, Medical Billing and Coding, ICD 9 and 10 Coding and Sales of Pharmaceutical Drug Plans. Subject Matter Expert in Medicare, Medicaid and Private Health Insurance. Call Center Support. Research and analyze claims process.
- Ability to work with others in a team environment.
- Ability to work under pressure.
- Collaborate amongst management, colleagues and peers.
- Operates as an office expert in one or several health care or business-related areas. Leads and/or contributes to the writing of the division’s Reimbursement Updates and / or written client/sales representative correspondence on reimbursement support programs.
Education
Associate Degree - Health Care Management
Kaplan University
Charlotte, NC01-2012
Associate Degree - Health Care Administration
York Technical College
01-2010
Skills
- Claims investigation
- Policy interpretation
- Claims management
- Case coordination
- Insurance policy knowledge
- Critical thinking
- Excellent communication
- Computer skills
- Team leadership
- Decision-making skills
- Claims adjustment
- MS office
- Complex Problem-solving
- Public speaking
Certification
North Carolina Property and Casualty License, South Carolina Property and Casualty License; Georgia Property and Casualty License, CT License, NH License, RI License, Alabama License, Mississippi License, Tennessee License.
Timeline
Workers Compensation Claims Adjuster
Gallagher Bassett
04.2021 - 04.2026
Workers Compensation Claims Adjuster
Best IRS - Contract - Gallagher Bassett
10.2020 - 03.2021
Workers Compensation Claims Adjuster
Gallagher Bassett Services, Inc.
01.2020 - 05.2020
Workers Compensation Claims Specialist
Corvel Corporation
03.2016 - 01.2020
Senior Site Coordinator
Lash Group Amerisource Bergen
11.2012 - 03.2016
Associate Degree - Health Care Management
Kaplan University
Associate Degree - Health Care Administration
York Technical College